Clinically relevant outcomes in dental clinical trials: challenges and proposals

Six-year clinical evaluation of a copper-containing universal adhesive in non-carious cervical lesions: A split-mouth double-blind randomized clinical trial

OBJECTIVES

To evaluate the clinical performance of a universal adhesive system containing 0.1 % copper nanoparticles (CuNp) in non-carious cervical lesions (NCCLs) after 6 years.

MATERIAL AND METHODS

Two hundred and sixteen restorations (n = 54) were randomly placed in 36 participants with at least four NCCLs. Groups included: ER-Cu (adhesive in etch-and-rinse strategy with CuNp), ER-Ct (etch-and-rinse without CuNp), SE-Cu (self-etch with CuNp), and SE-Ct (self-etch without CuNp). Restorations were evaluated at baseline and after 1, 3, 4, and 6 years using the FDI and USPHS criteria.

PRIMARY OUTCOME

fracture of material and retention. Examiners and patients were blinded to group assignment.

RESULTS

After 6 years, 104 restorations were analyzed (ER-Cu 24, ER-Ct 29, SE-Cu 27, SE-Ct 24). Fourteen restorations loss retention (ER-Cu 6, ER-Ct 1, SE-Cu 2, SE-Ct 7). Retention rates (95 % confidence interval) were 79.3 % (61.6 - 90.1) for ER-Cu; 97.0 % (83.3 - 99.4) for ER-Ct; 93.1 % (78.1 - 98.1) for SE-Cu; and 76.7 % (59.1 - 88.2) for SE-Ct, with statistical differences between SE-Cu vs. ER-Ct, and SE-Ct vs. ER-Ct (p < 0.05). Thirty-one restorations (ER-Cu 6, ER-Ct 5, SE-Cu 9, SE-Ct 11) showed minor marginal staining, and forty-one restorations (ER-Cu 8, ER-Ct 10, SE-Cu 11, SE-Ct 12) presented minimal marginal adaptation defects (p > 0.05). No significant differences were found for other secondary parameters (p > 0.05).

CONCLUSION

This is the first 6-year clinical trial showing the long-term behavior of a universal adhesive system in NCCLs. The addition of CuNp does not affect the clinical performance of the universal adhesive.

Influence of different viscosity and chemical composition of flowable composite resins: A 48-month split-mouth double-blind randomized clinical trial

OBJECTIVES

To evaluate the clinical performance of two flowable composites based on methacrylate and one based on ormocer in treating non-carious cervical lesions (NCCLs) after 48-month evaluation in a split-mouth double-blind clinical study design.

METHODS

A total of 183 restorations were performed on NCCLs using a universal adhesive system (Futurabond U, Voco GmbH) with selective enamel etching on 27 participants: two participants received twelve restorations each, three received nine restorations each, and 22 participants received six restorations each. Three different flowable composites were employed (n = 61): a low-viscosity methacrylate-based composite (GrandioSO Flow, LVM), a high-viscosity methacrylate-based composite (GrandioSO Heavy Flow, HVM), and an ormocer-based flowable composite (Admira Fusion Flow, ORM). All restorations were evaluated using FDI and USPHS criteria after 48 months. Statistical analysis was conducted using Kaplan-Meier Survival analysis and Kruskal-Wallis analysis of variance rank (α = 0.05).

RESULTS

After 48 months, 17 restorations were lost: LVM 6, HVM 9, ORM 2. The retention rates (95 % confidence interval) were 89.4 % for LVM, 80.4 % for HVM, and 95.6 % for ORM, with a significant difference between HVM vs. LVM and HVM vs. ORM (p < 0.05). Minor defects were observed in 30 restorations for marginal staining criteria (LVM 12, HVM 10, ORM 8) and in 71 restorations for marginal adaptation criteria (LVM 24, HVM 20, ORM 27) without significant difference between groups (p > 0.05). No restorations showed postoperative sensitivity or recurrence of caries.

SIGNIFICANCE

The increased viscosity of flowable composites could reduce the clinical longevity in NCCLs after 48 months. Ormocer-based and low-viscosity methacrylate-based flowable composites showed a successful clinical performance in NCCLs after 48 months.

Challenges in conducting clinical research in primary care dentistry

The integration of dentistry into primary health care is crucial for promoting patient well-being. However, clinical studies in dentistry face challenges, including issues with study design, transparency, and relevance to primary care. Clinical trials in dentistry often focus on specific issues with strict eligibility criteria, limiting the generalizability of findings. Randomized clinical trials (RCTs) face challenges in reflecting real-world conditions and using clinically relevant outcomes. The need for more pragmatic approaches and the inclusion of clinically relevant outcomes (CROs) is discussed, such as tooth loss or implant success. Solutions proposed include well-controlled observational studies, optimized data collection tools, and the integration of artificial intelligence (AI) for predictive modelling, computer-aided diagnostics and automated diagnosis. In this position paper advocates for more efficient trials with a focus on patient-centred outcomes, as well as the adoption of pragmatic study designs reflecting real-world conditions. Collaborative research networks, increased funding, enhanced data retrieval, and open science practices are also recommended. Technology, including intraoral scanners and AI, is highlighted for improving efficiency in dental research. AI is seen as a key tool for participant recruitment, predictive modelling, and outcome evaluation. However, ethical considerations and ongoing validation are emphasized to ensure the reliability and trustworthiness of AI-driven solutions in dental research. In conclusion, the efficient conduct of clinical research in primary care dentistry requires a comprehensive approach, including changes in study design, data collection, and analytical methods. The integration of AI is seen as pivotal in achieving these objectives in a meaningful and efficient way.

Prolonged polymerization of a universal adhesive in non-carious cervical lesions: 36-month double-blind randomized clinical trial

OBJECTIVE

To evaluate the effect of prolonged (P) polymerization time of a universal adhesive system applied in etch-and-rinse (ER) or self-etch (SE) strategies on the clinical performance of restorations in non-carious cervical lesions (NCCLs), after 36 months of clinical service.

METHODS

A total of 140 restorations were randomly placed in 35 subjects according to the polymerization time groups: ER (10 s); ER-P (40 s); SE (10 s); and SE-P (40 s) at 1,200 mW/cm2. Composite resin was placed incrementally. The restorations were evaluated immediately and after 6, 12, 18, and 36 months using the FDI criteria. Data were analyzed using the Kaplan-Meier survival test for retention loss, and the Kruskal-Wallis' test for secondary outcomes (α = 0.05).

RESULTS

After 36 months, 19 restorations were lost: ER 6, ER-P 2, SE 9, SE-P 2. The retention rates were 82.3% for ER; 94.1 % for ER-P; 73.5 % for SE; and 94.1 % for SE-P, with a significant difference between ER vs. ER-P and SE vs. SE-P, as well as ER vs. SE-P and ER-P vs. SE (p < 0.0001). Minor defects were observed in 18 restorations for the marginal staining criteria: ER 5, ER-P 2, SE 8, SE-P 3; and in 33 restorations for the marginal adaptation criteria: ER 11, ER-P 4, SE 12, and SE-P 6 (p > 0.05). No restorations showed recurrence of caries or postoperative sensitivity.

CONCLUSIONS

A prolonged polymerization time of 40 s improves the clinical performance of the universal adhesive for both adhesive strategies evaluated, even after 36 months.

CLINICAL SIGNIFICANCE

Prolonging the polymerization time of a universal adhesive from 10 to 40 s has been shown to improve its clinical performance when used in NCCLs.

GLOSSARY FOR DENTAL PATIENT-CENTERED OUTCOMES

Dental patient-centered outcomes can improve the relevance of clinical study results to dental patients and generate evidence to optimize health outcomes for dental patients. Dental patient-reported outcomes (dPROs) are of great importance to patient-centered dental care. They can be used to evaluate the health outcomes of an individual patient about the impact of oral diseases and treatment, and to assess the quality of oral health care delivery for a health care entity. dPROs are measured with dental patient-reported outcome measures (dPROMs). dPROMs should be validated and tested before wider dissemination and application to ensure that they can accurately capture the intended dPROs. Evidence suggests inadequate dPRO usage among dental trials, as well as potential flaws in some existing dPROMs. This Glossary presents a collection of main terms in dental patient-centered outcomes to help clinicians and researchers read and understand patient-centered clinical studies in dentistry.

Influence of daily usage times on patients' compliance during at-home bleaching: a randomized clinical trial

The effectiveness of at-home dental bleaching treatments depends on the time that bleaching products are in contact with the teeth surface and, consequently, on the adequate use of associated custom acetate trays.

OBJECTIVE

This randomized single-blinded trial aimed to analyze if the daily usage time of these products influences the patient's compliance behavior when submitted to monitored at-home dental bleaching. Secondary outcomes were color change and tooth sensitivity.

METHODOLOGY

Sixty-six volunteers were randomly distributed into three groups (n=22): patients were instructed to use the trays for 2 (G2), 4 (G4), and 8 (G8) hours daily. The daily dental bleaching compliance behavior was measured using a microsensor inserted into the trays. Subjective and objective color evaluation assessments were adopted at baseline (T0), one (T1), two (T2), and three weeks (T3) after the beginning of the bleaching treatment, as well as two weeks after the treatment (T4). Tooth sensitivity was analyzed using the VAS scale, ranging from T1 to T4.

RESULTS

G2 showed a greater degree of cooperation than G8 and cooperation was inversely proportional to the recommended usage time. Significantly higher color change was observed in the upper arch for G8 when compared to G2 in subjective analysis, from T1 to T4. There were no statistical differences between the groups in objective analysis.

CONCLUSION

Shorter recommended usage time of the bleaching product may improve the patient's compliance with at-home dental bleaching treatments. However, increased daily usage time may promote better subjective color change. Bleaching sensitivity was more significant in the first week for a longer time of use.

Some Myths in Dentin Bonding: An Evidence-Based Perspective

Laboratory investigations are essential models responsible for science development. However, laboratory discoveries must be confirmed in a clinical environment where many known and unknown variables and complex mechanisms are involved. Using conclusions from laboratory studies to make clinical recommendations can lead to widespread "unreliable truths" or so-called myths in any field of knowledge. These myths may increase the costs (financial and time) or even cause harm (side effects) that would be unnecessary, given that the current protocol or conduct was previously evaluated in a more complex and complete clinical setting. This article will discuss certain myths in dentin bonding that may influence clinical decision-making, bringing some principles of evidence-based practice to allow a more critical evaluation of the literature findings.

Effect of adhesive strategy of universal adhesives in noncarious cervical lesions - an updated systematic review and meta-analysis

OBJECTIVE

To determine the effect of adhesive strategy (total etch or self-etch) of universal adhesives in non-carious cervical lesions.

DATA SOURCE

A search was made in PubMed, Scopus, Cochrane, Web Of Science, Open Gray, Clinical Registries.

DATA SELECTION

Randomized Controlled Clinical Trials, studies on non-carious cervical lesions restored using Universal Adhesives, and studies in which universal adhesives have been used in total etch and self -etch strategies were included in this systematic review.

DATA EXTRACTION

A total of 17 articles were included in the systematic review and 13 in the meta-analysis. Meta-analysis was conducted to assess the clinical performance of NCCLs in terms of retention, marginal adaptation, marginal discoloration, secondary caries and post-operative sensitivity at 18, 24, 36 month follow-up using USPHS as well as FDI criteria, separately.

DATA SYNTHESIS

Overall there was no significant difference between total etch and self etch adhesive strategies for any of the five outcome measures using either the FDI or the USPHS criteria. p > 0.05, 95% CI, I² value of 0%. A strongly suspected publication bias in the retention domain was seen at 18 month follow up under FDI criteria.

CONCLUSION

Most universal adhesives show acceptable clinical performance. There is no significant effect of the adhesive strategy of universal adhesives on their clinical performance according to the results of our meta-analysis.

Selective outcome reporting bias is highly prevalent in randomized clinical trials of nonsurgical periodontal therapy

Selective outcome reporting (SOR) is a type of bias that can compromise the validity of results and affect evidence-based practice. SOR can overestimate the effect of an intervention and lead to conclusions that a treatment is effective when it is not. This study aimed to investigate the prevalence of SOR in publications of RCTs on nonsurgical periodontal therapy (NSPT) and to verify associated factors. The protocols were searched and selected on the www.clinicaltrials.gov platform up to January 16, 2022. Corresponding publications were identified, and data extraction and discrepancy analysis were performed. The risk of bias was assessed according to the RoB2 tool. One hundred forty-five studies (174 publications) were included. The prevalence of SOR was 49.7% and was unclear in nearly one third of studies (27.6%). Only 31.7% of the primary outcomes were completely described in the publications. The overall risk of bias was high in 60% of the included studies. SOR was associated with statistical significance (p < .001), and multiple publications of the same study (p = .005). Our study demonstrated the high prevalence of SOR, highlighting the need to improve the quality of reporting of RCTs on NSPT studies.

Exploring the contextual factors, behaviour change techniques, barriers and facilitators of interventions to improve oral health in people with severe mental illness: A qualitative study

People with severe mental illness (SMI) have significantly poorer oral health compared to people without SMI and interventions targetted to improve oral health in this population failed to show any long-term improvement. Interventions are influenced by many contextual factors ranging from individual to systems level. This study aimed to understand the contextual factors, behaviour change techniques of the available oral health interventions and explore the barriers to and facilitators for engagement with these interventions from the perspectives of people with SMI (service users) and related service providers. Intervention details were extracted from 12 intervention studies identified from a previous systematic review using the template for intervention description and replication checklist (TIDieR) and behaviour change techniques (BCTs) were coded using the behaviour change technique taxonomy v1. Sixteen individual BCTs were identified and out of which "4.1 instructions on how to perform the behaviour" (n = 9) and "6.1 demonstration of behaviour" (n = 6) were most frequently used BCTs. Video vignettes prepared from the different intervention components identified from existing studies were shown to service users and service providers in dyadic or one-to-one interview format to elicit their views on barriers and facilitators for engagement with the intervention components. Interviews were analysed using Framework analysis and were guided by theoretical domains framework (TDF); and capability, opportunity and motivation (COM-B) model of behaviour change. Main facilitators identified to increase capability, opportunity and motivation of service users were the involvement of carers/care coordinators and integration of dental and mental health care, provision of oral health/hygiene information/products at an appropriate level and provision of tailored support according to individual needs and preferences. Barriers identified were related to lack of communication skills of the service providers, provision of coordinated care, lack of support in visiting a dentist and navigating the payment system and long follow up times. Appropriate training was considered as a facilitator, and staff turnovers and workload were considered as main barriers by the service providers. The findings suggest that comprehensive interventions that target barriers and enhance facilitators from individual to systems level are needed to improve oral health outcomes of people with SMI.

Fixed Orthodontic Treatment Increases Cariogenicity and Virulence Gene Expression in Dental Biofilm

Background: Dental caries commonly occurs during orthodontic treatment because fixed appliances can impede effective oral hygiene practices. This study investigated the effects of fixed orthodontic treatment on dental biofilm maturity and virulence gene (gtfB, ldh, brpA, spaP, luxS, and gbpB) expression. Methods: Dental biofilms and virulence gene expression were determined in 24 orthodontic patients before and after treatment of ≥6 months. A three-tone disclosing gel was used to stain dental biofilm and assess its maturity by its color change—pink (new dental biofilm), purple (mature dental biofilm), and light blue (cariogenic dental biofilm). Gene expression levels were determined using real-time PCR. Results: After fixed orthodontic appliance insertion, the percentage of new dental biofilm decreased, whereas that of cariogenic dental biofilm significantly increased (p < 0.05). There was no significant difference in the percentage of mature dental biofilm (p > 0.05). Fixed orthodontic appliances increased gtfB, ldh, brpA, and gbpB gene expression above 1.5-fold in dental biofilm. In contrast, there was no change in spaP or luxS gene expression after treatment. Conclusions: Fixed orthodontic appliance insertion induced ecological changes and cariogenic virulence gene expression in dental biofilm.

Rehabilitation of full-arch edentulism with fixed or removable dentures retained by root-form dental implants: A systematic review of outcomes and outcome measures used in clinical research in the last 10 years

AIM

To evaluate outcome measures, methods of assessment, and analysis in clinical studies on the rehabilitation of full-arch edentulism with implant-supported fixed or removable prostheses.

MATERIALS AND METHODS

A protocol-oriented search was conducted in MEDLINE via PubMed, EMBASE, and Cochrane Library (PROSPERO registration CRD42021265179) from 1 January 2011 to 27 July 2021 to identify longitudinal studies reporting on the rehabilitation of edentulous patients with implant-supported prostheses. The primary aim of this study was the collection of all objectively reported outcomes in each study. Secondary aims included the description of the methods of assessment and analytical methods. Risk of bias was applied according to the study design (randomized controlled trial, cohort study, or descriptive pre-post study). Individual study data were extracted into an outcomes matrix. Outcomes were grouped into domains and descriptively analysed. A network diagram was generated to establish relationships between domains. The present review follows the PRISMA statement.

RESULTS

The screening and selection processes resulted in the identification of 491 publications, corresponding to 421 different studies (cohorts of patients). Only 24% of the studies reported the use of EQUATOR network guidelines. Implant failure/survival was the most reported outcome (270 studies), but the criterion to determine implant failure and/or survival was frequently not described or was ambiguous. Implant success was much less frequently reported (88) and was based on several heterogenous composite definitions. Marginal bone levels (233 studies), technical complications (158), and clinical outcomes (150), including peri-implant soft tissue and implant stability assessment, were also frequently reported. Patient-reported outcome measures (PROMs) (145) and function-based outcomes (40) were predominantly reported in isolation from other outcomes and most frequently in removable restorations. While quality of life was evaluated using valid instruments, patient satisfaction was evaluated based on a common sense concept of satisfaction. Economic outcomes were under-reported (13).

CONCLUSIONS

There is great heterogeneity in the criteria to define implant failure or survival and implant success, which prevents the comparison of rates across studies. Even though studies frequently report multiple outcomes, PROMs are usually reported in isolation from other outcomes. It would be valuable to have a set of core outcome variables and standardized methods of measurement for future studies.

The effects of corticotomy and piezocision in orthodontic canine retraction: A randomized controlled clinical trial

Background:

There have been many studies and experiments to evaluate the effectiveness of different types of dental treatment. Maxillary canine extraction is such a dental treatment which can be performed through either alveolar corticotomy (AC) or piezocision (PZ). The current study aims to compare the effectiveness of these two types of dental procedures. It is based on a randomized clinical trial (RCT) through the split-mouth technique supported by a parallel group design. The participants in the trial were selected on the basis of a medical criterion. The clinical trial involved extraction of both the first maxillary premolar teeth through use of orthodontic instruments. This study aims to evaluate the comparative effectiveness of alveolar corticotomy and piezocision corticotomy in acceleration of maxillary canine retraction and how it can be used for expression of multiple bone remodeling gingival crevicular fluid (GCF). As part of this study, a RCT was performed on the basis of split-mouth technique at the Department of Orthodontics of Pontifical Catholic University at Minas Gerais in Brazil. The sample size for the clinical trial consisted of people who required extraction of maxillary premolar teeth after canine extraction. After digital intraoral scans, the cumulative distal movement of canines was measured on the basis of superimposition of digital model and the results were considered as the primary outcome of the study. The GCF bone remodeling samples were considered as the secondary outcomes.

Results:

50 patients, involving 22 males and 28 females were analyzed in this particular clinical trial. The age range that was considered for this clinical trial was 19–33 years. In case of understanding the distal movement between control and AC, no statistical significance was observed in Group1 (G1). Lower cumulative cervical and incisal measurements in case of PZ was lower than the measurement in the control state. In all the groups, the expression of the biomarkers had occurred in specific timepoints (P < 0.05) but no distinct pattern was observed.

Conclusions:

In order to accelerate the maxillary canine retraction, PZ and AC were ineffective. No distinct induction pattern of biomarker expression was noted as well.

Smoking Cessation therapy is a cost-effective intervention to avoid tooth loss in Brazilian subjects with periodontitis: an economic evaluation

Background

Smokers present a higher prevalence and severity of periodontitis and, consequently, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. So, the aim of this study was to evaluate the efficiency in resources allocation when implementing smoking cessation therapy vs. its non-implementation in smokers with periodontitis.

Methods

We adopted the Brazilian public system perspective to determine the incremental cost-effectiveness (cost per tooth loss avoided) and cost-utility (cost per oral-related quality-adjusted life-year ([QALY] gained) of implementing smoking cessation therapy. Base-case was defined as a 48 years-old male subject and horizon of 30 years. Effects and costs were combined in a decision analytic modeling framework to permit a quantitative approach aiming to estimate the value of the consequences of smoking cessation therapy adjusted for their probability of occurrence. Markov models were carried over annual cycles. Sensitivity analysis tested methodological assumptions.

Results

Implementing the therapy saved approximately US$ 100 over the time horizon accompanied by a slightly better effect, both in CEA and CUA. Considering uncertainties, the therapy could be cost-effective in the most part of simulated cases, even being cheaper and more effective in 35% of cases in which the oral-health related outcome is used as effect. Considering a willingness-to-pay of US$100 per health effect, smoking cessation therapy was cost-effective, respectively, in 72% and 99% of cases in cost-utility and cost-effectiveness analyses.

Conclusions

Implementation of smoking cessation therapy may be cost-effective, considering the avoidance of tooth loss and oral health-related consequences to patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01932-2.

Randomized clinical trials in periodontology: focus on outcomes selection

Randomized clinical trials (RCTs) are human studies carried out to compare different treatments or interventions, and their results are used to support clinical decision-making and improve patient care. Herein, the aim of this study was to review the selection process of study outcomes in periodontology. Primary outcomes should draw the main conclusions of the study, whereas secondary outcomes should only be used to help explain the main findings and generate future research hypothesis. Outcomes are classified as clinically relevant (CROs) or surrogate outcomes. CROs - the first option for primary outcome variables - should convey not only substantial health benefits, but also be deemed important by patients. In periodontology, tooth loss/retention and oral health-related quality of life (OHRQoL) are examples of CROs. While tooth loss has main limitations as a primary outcome, emerging evidence suggest that patient-reported outcome measures (PROMs) can accurately detect OHRQoL following periodontal therapy. When CROs cannot be assessed, validated surrogate outcomes can be used as proxies. Primary outcome variables should reflect a treatment endpoint at the patient level that can be easily used to inform decision-making in daily practice. These outcomes should allow the implementation of a treat-to-target concept in which the intervention can be clearly judged against a prespecified treatment target. Recently, the presence of at most 4 sites with periodontal probing depth ≥5 mm post-treatment was suggested as an effective endpoint for periodontal trials. In perspective, a combination of validated clinical parameters and PROMs will provide a more comprehensive assessment of periodontal treatments.

Is clinical behavior of composite restorations placed in non-carious cervical lesions influenced by the application mode of universal adhesives? A systematic review and meta-analysis

OBJECTIVE

To answer the following PICOS question: "Is the risk of retention loss, marginal discoloration, marginal adaptation and postoperative sensitivity (POS) equal for etch-and-rinse (EAR) compared to self-etch (SE) or selective-enamel etch (SEE) mode when restoring non carious cervical lesions (NCCLs) with universal adhesives?".

METHODS

PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, LILACS, OpenGrey and Google Scholar™ were searched. Randomized controlled clinical trials in which resin composites and universal adhesives were used for restoration of NCCLs were considered. Cochrane Risk of Bias Tool was used to assess the risk of bias. Meta-analyses were performed using Revman; random-effects models were applied, and heterogeneity was tested using the I² index. The significance level was set at p < 0.05. Certainty of evidence was assessed by GRADE tool.

RESULTS

After screening, 20 articles were included in qualitative, while 14 articles were used for quantitative synthesis. Twelve studies ranked as "low", while 8 studies scored as "unclear" for risk of bias. At 12- and 18/24-months the risk for retention loss was higher for SE than for EAR groups (p = 0.005; RR = 0.22, 95% CI [0.08, 0.63],[moderate certainty of evidence and p = 0.0002; RR = 0.32, 95% CI [0.17, 0.58], moderate certainty of evidence, respectively). No significant differences were observed for marginal discoloration and adaptation (p > 0.05). The probability of POS occurrence was less in SE than in EAR groups (RR = 2.12, 95% CI [1.23, 3.64], moderate certainty of evidence). The certainty of evidence for other outcomes was scored as "low" or "moderate", depending on the follow-up period.

SIGNIFICANCE

Using universal adhesives in EAR or SEE mode provides more predictable retention, while SE strategy reduces the risk of POS occurrence.

COMPLIANCE OF RANDOMIZED CLINICAL TRIALS ON DENTAL CARIES PREVENTION METHODS WITH THE CONSORT STATEMENT: A SYSTEMATIC REVIEW

OBJECTIVE

Reporting of randomized controlled trials (RCTs) in dentistry remains suboptimal. Considering the positive impact of the Consolidated Standards of Reporting Trials (CONSORT) guidelines on the quality of evidence in RCTs, the main objective of this systematic review was to determine whether RCTs on dental caries prevention conform to these guidelines. The secondary objective was to assess the association between CONSORT adherence and the year and impact factor of the journal in which the study was published.

METHODS

A systematic search was conducted in different databases using appropriate terms to retrieve RCTs that assessed the caries-preventive effect of at least 2 of the following materials-fluoride varnish, resin-based fissure sealants, and ionomer-based fissure sealants-on the occlusal surfaces of permanent molars. Since the first CONSORT statement was published in 1996, a time frame from 1997 to 2020 was established for the identification of studies. Selected articles were assessed according to their adherence to the CONSORT statement, risk of bias (Cochrane risk of bias tool, RoB 2.0), and journal impact factor based on the InCites Journal Citation Reports. The year of publication and other relevant data were also recorded. SPSS (SPSS Statistics 25.0, IBM©) was used to perform the linear correlation analyses to determine the relationship between the article CONSORT score (previously determined) and the year of publication and journal impact factor. A significance level of 5% was established for all analyses.

RESULTS

Of 3196 references retrieved, 30 articles were selected and evaluated. Using RoB 2.0, 8 studies were classified as having a high risk of bias, 16 as having some concerns about the risk of bias assessment, and 6 as having a low risk of bias. Concerning CONSORT adherence, 77% of the studies adequately reported the intervention domain, since the methodology for the application of fluoride varnish or sealant materials was thoroughly described. However, the participants' setting and location, random sequence generation, randomization, and the flowchart description of the losses/exclusions domains were poorly reported. Meanwhile, the allocation concealment process was not reported in 83% of the articles. Correlation analyses indicated a positive relationship between CONSORT adherence and the year of publication, as well as the journal impact factor.

CONCLUSION

When assessing clinical trials on the prevention of occlusal caries, most RCTs examined followed the CONSORT statement. However, some methodological domains remain poorly reported, demonstrating the need to improve CONSORT compliance in these RCTs.

The effect of chlorhexidine primer application on the clinical performance of composite restorations: a literature review

To discuss the effectiveness of chlorhexidine (CHX) used as therapeutic dentin primer in adhesively bonded composite restorations. OVERVIEW: An electronic search in MEDLINE database, accessed through PubMed was conducted. No restrictions of languages and date of publication were made. The following key words were used: "chlorhexidine", "composite" and "composite resins." Clinical studies in which CHX was used during bonding procedures were included in this review. Six studies met the inclusion criteria. Of these, five studies were carried out on noncarious cervical lesions (NCCL). Only one study was carried out on class II preparation of permanent molars. In all studies, either etch-and-rinse and self-etch adhesive systems were used during bonding procedures. On the basis of the reviewed clinical trials, it can be concluded that CHX primer application does not seem to influence clinical outcome of composite restorations. CLINICAL SIGNIFICANCE: Current scientific evidence cannot neither strongly recommend nor discourage the application of CHX as therapeutic primer in composite restorations. Studies with longer follow-up periods with adhesive restorations placed on dentin after caries removal, rather than only on NCCL, are desirable to further investigate the therapeutic effect of CHX during bonding procedures.

Transparency in clinical trials: Adding value to paediatric dental research

BACKGROUND

Even though considered as studies with high methodological power, many RCTs in paediatric dentistry do not have essential quality items in their design, development, and report, making results' reliability questionable, replication challenging to conduct, wasting time, money, and efforts, and even exposing the participants to research for no benefit.

AIM

We addressed the main topics related to transparency in clinical research, with an emphasis in paediatric dentistry.

DESIGN

We searched for all controlled clinical trials published from January 2019 up to July 2020 in the three paediatric dentistry journals with high journal Impact Factor, indexed on Medline. These papers were assessed for transparency according to Open Science practices and regarding reporting accuracy using some items required by CONSORT.

RESULTS

53.6% of the studies declared registration, 75% had sample size calculation, 98.2% reported randomisation, and from those, 65.4% explained the randomisation method. Besides that, no study shared their data, and 6.8% were published in open access format.

CONCLUSIONS

Unfortunately, a large proportion of RCTs in paediatric dental research show a lack of transparency and reproducibility.

How researchers should select the best outcomes for randomised clinical trials in paediatric dentistry?

Randomised clinical trial (RCT) is the best study design to evaluate the effect of the treatment and preventive healthcare procedures. The effects of the tested treatments on patient's health are compared in terms of outcomes, which are used to evaluate the participants' health changes. However, these outcomes should be relevant for the target population. In that way, RCTs represent the type of primary study design that provides the most reliable evidence to implement therapies into the clinical practice. In this review, an outline of some aspects related to the choice of RCTs' outcomes was presented, focusing on the conduction of relevant trials in Paediatric Dentistry. The importance and necessity of defining a primary outcome were addressed, preferentially a clinically relevant endpoint. The patients should perceive this outcome, and changes in this variable should reflect directly patient's health improvement or impairment. Moreover, considerations about the objective or subjective variables, use of surrogate outcomes, and the increasing tendency to develop core outcome sets were also presented in this review. The main idea of this manuscript is the RCTs must evaluate outcomes relevant to the children's oral health in order to contribute to the implementation of treatments in the evidence-based health practice.